=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063430130
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID B STUETELBERG D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 02/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 DEL WEBB BLVD SUITE 103
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78633-4354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-864-2880
-----------------------------------------------------
Fax | 512-864-2411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 DEL WEBB BLVD SUITE 103
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78633-4354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-864-2880
-----------------------------------------------------
Fax | 512-864-2411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 6785
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------